Further Conversations On Body Image: Examining Health at Every Size (HAES)

Health at every size is a concept embraced by some fat and size acceptance activists. For those not familiar with it, it was developed popularised (see comments) by Linda Bacon, and simply put, it suggests that there’s a wide variation of bodies and that people should focus on what makes their bodies healthy, rather than on eating and exercising for weight control. There are a number of components of health at every size, including ‘intuitive eating’ and the concept of ‘joyful movement.’

When I initially heard about HAES back in my nascent days of exploring fat, size, and my relationship with my own body, I was excited about it. I’d been reading a lot of stories about the false beliefs about fat and health, and I liked the idea of a movement specifically reinforcing the idea that being fat doesn’t make you unhealthy, since one of the most common charges levied against us fat folks is that we are unhealthy because we are fat, that fat makes people unhealthy.

But then I got sick. Very, very sick. And I lost a lot of weight, and people praised me for it, and I started thinking about the dichotomies being set up with health at every size, and who was being left out of this equation: People who are unhealthy. Many people are unhealthy and also fat, many people are fat and disabled, and the framing of health at every size excludes them.

It’s hard to eat intuitively when you have allergies, or when you have conditions that require you to be very careful about what you eat for other reasons. When you’ve got to plan out your meals and you can’t afford to be ‘intuitive,’ to decide to skip a meal when you don’t feel like eating. It’s hard to eat intuitively also when you have limited energy for cooking and you might not be able to eat when you want, when you want. Or when you’re so sick that the thought of eating at all is nauseating.

As for ‘joyful exercise,’ well, not all bodies want to move, and not all bodies move joyfully. I know that I personally tend to feel better, emotionally, when I do yoga regularly. Which is great, for me. But I’m not going to tell other people to do yoga; some people find the poses difficult to hold or the experience uncomfortable or just plain don’t like it. For people who like to move and want to move, finding the ways that their bodies move comfortably and joyfully is awesome, but not everyone wants that, and not everyone can reach that. Should someone who can’t exercise be drummed out of the fat acceptance movement?

I want to be clear that not all fat/size activists embrace this concept, and that some of those who do think of it as a framework that works for some people, and not for others, that people need to navigate their own relationships with their bodies rather than being forced to think about them in a particular way, acknowledging the variation of human experience and emphasising the fact that people should not be told how to feel about their bodies. But, for those who accept it as a blanket, one size fits all (so to speak) philosophy, there tends to be an erasure of people with disabilities from the size acceptance movement; we’re not healthy, so right there, we’ve gone and shot a big hole in health at every size, no matter why we are unhealthy, no matter what the intersections (or lack thereof) between our health and weight may be.

Which is unfortunate, because size acceptance needs to work for us, too. Many of the FWD contributors, just for example, are fat to varying degrees, and I know we have a lot of fat readers. Our fat bodies need to be accepted and embraced too and we need to be able to talk about our relationships with our bodies; how, for example, people with poor thermoregulation experience chub rub on a whole new and very uncomfortable level. We need to talk about what it’s like to not be healthy at every size.

I’m not advocating for throwing out HAES. There are a lot of people who clearly benefit a lot from this model and for whom it has played an important role in thinking about their bodies and their relationship with the world. But we also need to find a way to create a space for discussions about fat and disability, for what it’s like to be happy and fat, happy and disabled, sad and fat, sad and disabled.

Hardline HAES advocacy plays directly into the good fatty/bad fatty dichotomy that looms so large in the minds of many of us. The stereotypes about ‘lazy fatties’ take on a new dimension when they are weaponised against people with disabilities who need to use mobility aids, who can’t hop off the couch and start cycling for fun, who experience feelings of guilt and inadequacy about being unable (or unwilling!) to exercise.

A huge part of fat acceptance is the idea that there are no ‘perfect’ bodies and that bodies naturally come in a wide range of sizes, colours, shapes. But bodies also naturally come in a wide range of degrees of disability and health, and that intersects directly with fatness, with social attitudes, with acceptance of the body.

It is sad that this even needs to be said, but given the fact that we essentially live in a health meritocracy, let me be the first to announce:

You are under no obligation to be healthy.

And, as an addendum: even if you were, eating “well” and exercising wouldn’t guarantee your success. There. I’ve said it. And as much as this might chap the ass of every health promoter out there, I feel that personal agency and a basic sense of privacy are sorely missing from most conversations of health promotion, and from conversations of Health at Every Size.

I’d recommend reading her whole post, as she talks about issues like varying definitions of ‘health’ and the pressure on members of society to be healthy, and poke around her blog a bit if you haven’t already, because this is not her only piece on the obligation to be healthy. Michelle’s work has done a lot for me personally in terms of reframing the way I think about fat and health, and I’m really excited that she’s tried to start a conversation about fat, health, and the shortcomings of HAES; let’s try to keep that conversation going.

About s.e. smith

s.e. smith is a recalcitrant, grumpy person with disabilities who enjoys riling people up, talking about language, tearing apart poor science reporting, and chasing cats around the house with squeaky mice in hand. Ou personal website can be found at this ain't livin'.
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I feel like the label HAES is used to encompass two related but different concepts. First is the idea that health isn’t correlated with size on a simple thin = good, fat = bad basis, and that different people’s “healthiest” weight is going to be different, which I think is not a particularly problematic idea. Second is the idea that, given this, people should eat perfectly intuitively and always engage in “joyful movement” and if you don’t do this, you’re doing something “wrong,” whereas if you do, you’re doing something “right.” I guess I wish we could come up with a better term for the first concept to decouple it from the second.

Thank you for this post. I’ve been trying to push back against Health At Every Size dominating every discussion in Fat Acceptance for quite a while. It’s not merely about good fatties and bad fatties, HAES is built on some very broad assumptions about class and access as well. If you are too poor to afford a variety of foods, you cannot eat intuitively. If you live in an environment where it isn’t safe or convenient to exercise, you cannot practice joyful movement. A lot of the time I feel like HAES has just replaced one widely unobtainable goal with another.

I’m glad you posted this. I totally agree that in the way that you’ve framed it, HAES creates another lens of Doing It Wrong to measure people against.

I am so fricking sick of people being told that they’re doing it wrong as regards their own bodies. And the bodies of their children, while we’re at it.

But maybe I have made up my own version in my head of what health at every size is, but to me, it’s less about the Rules of Exercise and Intuitive Eating, and much more of a harm reduction approach to eating and movement–which is that everyone has difficulties trying to figure out what’s best for their body for tons of complex reasons, and that whatever positive stuff you come up with in the context of your own life and circumstances is good. And that can change. And it’s really individual for everyone. And if you’ve got some stuff going on that makes food more of an central concern (like diabetes), then it’s probably a good idea to think about changing around the way you eat so that you don’t end up with more difficulties down the way–but in the end, it’s your body, and you can do whatever the funk you want with it.

Which may mean eating sufficient calories, regardless of where they’re from, or eating in a way that acknowledges allergies if you’re a celiac that would like some f*#$ing pizza (ahem, theoretically) but know it will cause some of your MS symptoms to flare up (again, theoretically). Now I want pizza.

But really, I never got the message that HAES had some far off standard of Exceptional Perfection that all of us are meant to achieve. But maybe I have made this up, because this is the way that I like to think about food and feeding and that HAES is judgey about people that don’t eat in the Absolutely Perfect Way?

Quick comment because it’s been a long day, but: This is a great post. I believe that HAES is great in theory, but can be extremely difficult to put into practice, particularly for some people with chronic pain and/or other conditions where they are in too much pain to move for, say, an hour a day, or cannot move specific body parts. For example, I can do the *bare minimum* of exercise currently suggested by whichever U.S. gov’t organization sends that suggestion down from on high (I think it’s currently 30 minutes per day, 5 days per week?). If I try to exercise more, that will result in more pain. If I do less, that sometimes results in more pain (except if I’m having a major pain flare, in which case exercise is usually out of the question). Same goes with food: some (most) days, cooking three healthy and 100% nutritionally-balanced meals from scratch is unrealistic because I don’t have the physical energy.

Thank you so much for sharing this. As someone who has struggled with eating normally (both over eating and under eating) and as someone who has various health issues these problems are at the front of my mind nearly every day. I’m sure the anxiety that comes with constantly not feeling like I’m being “good enough” doesn’t help me on any count. Even though I know that it’s not my fault it’s been very hard for me to let that notion go.

Thank you for this post. It has made me think about HAES and FA from a different perspective. I am an FA blogger, and some of the people closest to me are PWD, but I’d never thought of HAES from a disability rights perspective before. I’d always seen it as an alternative to fat=unhealthy and thin=healthy, but it would seem that by pushing against our opression as fat people, we may be inadvertantly oppressing PWD (disclaimer: intent is not an excuse), and minorities need to help each other, not make things worse. This has given me ideas for posts, and I hope I can spread knowledge of this issue throughout the Fatosphere.

Intuitive eating? That’s a strange concept to me. I don’t actually get hungry. I go straight from not hungry to oh gods I’ve fainted. I don’t consider it a disability, but it is one of the reasons I’m often underweight and is either the cause of or caused by other health problems… Possibly both.

And that’s not even getting into the times when my depression makes it pretty impossible to get the energy together to eat.

So yeah, HAES is not the movement for me. But I am a ful, supporter of FA and shame-free eating.

I’m not sure how common the lack of a “hunger” sensation that PharaohKatt described is, but I don’t have one either. Weak yes, dry mouth or throat yes, cramps yes, but no specific hungry feeling. I’m not sure whether it’s linked to one disability or other, although I’m likely Aspergic.

A couple quick comments. First, I want to make a correction: I didn’t develop HAES – it was around long before I got involved. I have conducted research on HAES, wrote a book with that title, and helped to popularize it. But HAES was in existence long before I came onto the scene and many people have worked together over the years to develop it. Next, you comment that “Many people are unhealthy and also fat, many people are fat and disabled, and the framing of health at every size excludes them.” Those of us who support, define and promote HAES acknowledge the first two aspects of your sentence. Many of us work hard to frame HAES in ways that are not exclusive to them and are actively working to fight the “healthism” you describe.

That minor criticism aside, I think your larger point is quite important and that we really have to make it more safe for people to live in whatever body they have and make whatever choices feel comfortable for them, without the “bad fatty” judgment. I also know how hard it is for many of my fat activist friends who are living with diseases that are often attributed to weight, to deal with “failed poster child syndrome.”

I think the biggest problem with this is the framing. When I read “you can be healthy at any size”, I see it as “you can live a healthy lifestyle at any size” instead of feeling affronted because I actually never will be healthy, but that’s just me. The language on its own is problematic. I have also seen a lot of HAES proponents add the caveat that it’s not mandatory, i.e. “We are showing you a way to get healthier if you are interested“, but not all of them. And some do forget that not everyone will be able to follow the instructions. Still, I have already seen several posts like this one, so I am confident that the message is slowly sinking in.